Hi Dr. Nase-

First let me says thanks for clarifying your tx regimen and
explaining things.


I just wanted to add my typical post tx response because it doesn't
seem to fit your definition of successful txs, yet I have noticed a
subtle cumulative improvement in my flushing.


As you probably know, I use the Lyra Yag as my mainstay. I've had
about 14-15 txs now and I'd say they've definately made a
difference... The pattern is always the same, I come out of tx red
hot full face and ears, wash my face, go into constriction for about
the rest of the day (which is typical for me after washing) and then
have that 2 days of barely any trouble. Also note I take clonidine
and clarith immediately after treatment having skipped doses just
prior to it... On day 3-4, the bottom drops out, I get hotter
easier, flush easier, this lasts for about 3-4 weeks. On week 4
something clicks and all the sudden there's a subtle change in the
intensity of my flushing.


I've never come out noticing bruising, if you mean blotches when you
say "matts", I guess you could say I have that granted washing
immediately probably skews my perception... I wouldn't say I'm white
for those 2 days, but I definately don't have much trouble, not sure
about skin signs.


I can say some txs I've unfortunately gone into not flushing much, a
result of pre-cleansing too close to the treatment. I could
speculate those were the least effective, but even then I'd say I
still got some result... Maybe having 2 out of the 15 that didn't do
much.


I imagine with all the Yags I've done, I should be much better :( ,
so maybe I haven't had as much success as I could have, but I can't
deny they've assisted...Granted I have very powerful neural
flushing.. I'm more a flash flusher. I know it's rosacea because
p&p's/skin sensitivity were my first symptoms for years..When this
began in earnest, my superficial vasculature must have been strong
as you couldn't tell I had rosacea until I flushed full on crimson.
It contributed to me getting "psychological" diagnosis a lot since
my flushing was so quick (yet powerful) and strangely absent in the
doc's office...I can only assume somehow my deep vasculature is much
worse off... Even now, save blotchy skin, if I wash, I can look
fairly normal if I don't flush.. I was one of the unfortunate souls
that took Accutane before low dose became noted as better... I took
a 40/60mg alternating dose instead of the 120mg they wanted me on. I
refused, but don't know if Accutane contributed my current issues
whether negatively or positively.


I just had my last Yag on May 19, and just started to notice when I
get my worst flush (nervousness), I feel worse than I look. Again
something seems to have clicked on week 4...I can only assume my
getting hotter and flushing easier for that time period, is because
my vessels were indeed damaged enough to do something.


Thought I'd throw my experience out there to give ppl a different
point of reference... I'm starting to realize in order to make any
head way with this thing, you have to be somewhat masochistic.

best wishes-
Kristen




--- In rosacea-support@yahoogroups.com, "drnase2000"
<drnase1000@h...> wrote:
> Andrew,
>
> Within 1 to 6 hours, you should notice individual vessels that are
> purplish in hue (veins) or deep/dark red (arterioles). If it is a
> full face erythema, you should notice "matts" or patches of what
> looks like bruising (not purpura or crusting). This is the ideal
> post treatment response. If you are white post treatment for one
to
> two days without any skin signs, then the laser has just caused a
> transient vascular bed constrictor response (e.g. no benefit).
>
> Geoffrey
>
> ----------------------------------------
> Dr. Geoffrey Nase
> Ph.D. Microvascular Physiologist
> www.drnase.com
> -----------------------------------------
>
>
>
>
> --- In rosacea-support@yahoogroups.com, "andrew_rosacea"
> <yahoo@a...> wrote:
> > Hi Geoffrey,
> >
> > Sorry...
> >
> > One other question I mean to ask in my previous post.
What "signs
> of
> > blood vessel coagulation" should we be looking for, post-
treatment?
> >
> > Andrew.
> >
> > --- In rosacea-support@yahoogroups.com, "drnase2000"
> > <drnase1000@h...> wrote:
> > > Andrew and Matija,
> > >
> > > Thank you for your patience. You asked some specific
questions
> > > about my personal treatment of rosacea – (1) What were my
> specific
> > > treatments, (2) How successful were they, and (3) Why have I
> > > remained in remission. First, let me reiterate that in my
book
> I
> > > devoted most of my discussion to treatments aimed at specific
> > > rosacea symptoms, severity, triggers and dual treatment of
> > > coexisting skin disorders. I did discuss my personal
treatment,
> > but
> > > underscored that everyone is unique and should follow
treatments
> > > based on their own specific symptoms (especially due to the
fact
> > > that I had rhinophyma, severe centrofacial swelling, and
severe
> > > flushing along with primary rosacea).
> > >
> > > I will try my best to highlight my treatments and clearance as
a
> > > result of the treatment:
> > >
> > > 1. One pulsed dye laser treatment and a series of 5 photoderm
> > > treatments – laser/IPL treatments were the best form of
> treatment
> > > for my facial redness, flushing and skin sensitivity
> (approximately
> > > 85% to 90% clearance of those specific symptoms). Pre-
flushing
> > > before treatment with hot coffee, oral niacin, topical niacin
> and
> > > topical L-arginine had a lot to do with my overall success
and
> > long
> > > standing results. The entire microvascular bed must be filled
> with
> > > blood for proper treatment. This has been emphasized at
several
> > > recent Laser conferences that I attended and journal articles
in
> > the
> > > publication process because some patients' skin turns white
> > > (blanches) when treatment starts due to sympathetic
constrictor
> > > fibers (or local nerve reflexes) from the stress or pain of
> > > treatment. When blanching occurs, treatment will fail. In
> fact,
> > if
> > > you leave the office with a white face and no signs of blood
> vessel
> > > coagulation, then treatment results will be minimal.
> > >
> > > 2. Long term low dose isotretinoin – 10 mgs per day for 6
> months
> > > and 5 mgs per day for 9 months. This was the best form of
> > treatment
> > > for my rhinophyma, centrofacial swelling, chronic dermal
> > > inflammation, neutrophil deposition, sebaceous gland
> hyperactivity,
> > > sebaceous gland hyperplasia, papules and pustules. Of those
> > > specific symptoms, this treatment regimen resulted in a 95% to
> 100%
> > > clearance and seems to be permanent due to the long term total
> dose
> > > taken. Is this part of the x-factor….maybe a part. The
experts
> > > agree that this form of treatment can sometimes permanently
> alter
> > > the entire disease process. In most cases, any dose over 10
mgs
> > per
> > > day will thin the epidermis (reversibly) and increase facial
> > > redness. At 5 mgs per day there is no better oral anti-
> > inflammatory
> > > medication (except possibly oral metronidazole). The Internet
> > > horror stories are mostly based on cystic acne patients taking
> 120
> > > mgs to 180 mgs per day (not 10 mgs or 5 mgs per day).
> > >
> > > 3. Pulse dosing with macrolide antibiotics Clarithromycin and
> > > Azithromycin – there is enough scientific, medical and
> anecdotal
> > > evidence that these two macrolides inhibit angiogenesis,
> especially
> > > during wound healing and post laser treatment. I was pulse
> dosing
> > > after laser treatments – did this help to decrease vessel
> regrowth
> > > during the all important 14 to 21 days post treatment? These
> are
> > > the best antibiotics for rosacea, hands down. But, not all
> > > insurance companies cover these antibiotics and very few
doctors
> > yet
> > > recognize these for rosacea. Is this part of the x-factor….
> > > possibly.
> > >
> > > 4. Moxonodine – for specific neural triggers, this was
superior
> to
> > > clonidine or beta blockers in my particular case. For strong
> > neural
> > > and hormonal triggers as a result of neural activation this
> > > decreased the intensity and duration of flushing by 40% to
50%.
> > > This was taken prior to laser treatments. After laser
> treatments
> > > and isotretinoin, I was basically back to pre-rosacea with no
> signs
> > > of rosacea, most of my triggers were gone…..but, I still had
> mild
> > > bouts of flushing during seminars, national meetings, medical
> > school
> > > teaching, etc. It is natural to experience sympathetic drive
> and
> > > dilator hormone release (e.g. cortisol and its cascade) during
> hour
> > > long speeches, meetings, etc. In fact, you would not be
normal
> if
> > > you did not. Due to my career, my extremely stressful
speeches,
> > > class loads and seminars, I opted for ETS. I was a perfect
> > > candidate for this based on symptomology. This did reduce the
> > > remaining trigger down to nill. I do not recommend ETS to
> rosacea
> > > sufferers (I think in all these years I only recommended it to
3
> > > rosacea sufferers….. out of hundreds). It is the very last
form
> of
> > > treatment for a specific cause of flushing that should not be
> > > considered until the patient has tried every single form of
> > > treatment, endured several years of specific symptoms, etc.
In
> > > fact, I am quite concerned that some ETS surgeons are now on
the
> > > Internet recommending ETS for rosacea. That is appalling.
> > >
> > > 5. Finding the right topical cleansers, moisturizers and
> > sunscreens
> > > (and staying away from irritating dermatologist recommended
> > > products) was also instrumental in my normalization process
and
> at
> > > remaining in remission. I cannot put a percentage on this or
a
> > > clearance value.
> > >
> > > 6. I also believe strongly in oral antioxidants (not so much
> > > topical antioxidants). I believe in ester C, grape seed
> extract,
> > > pycnogenol, and alpha lipoic acid (R) based on their proven
> > > protective and strengthening actions on blood vessel walls. I
> > > cannot put a percentage on these antioxidants or a clearance
> > value.
> > > It is more for prevention and their anti-inflammatory
qualities.
> > >
> > > As you both know there are dozens of other treatments – oral
> > > medications, topical medications, skincare therapies and
> > > naturopathic approaches that will help the majority of mild to
> > > moderate rosacea sufferers. The above treatments are just the
> > > highlights of treatments that I used for MY specific case.
> > >
> > > Take care,
> > >
> > > Geoffrey
> > >
> > > ----------------------------------------
> > > Dr. Geoffrey Nase
> > > Ph.D. Microvascular Physiologist
> > > www.drnase.com
> > > -----------------------------------------